Childhood sexual abuse and cholesterol risk: Testing body mass index as a mediator across gender in a national sample of adults☆,☆☆

Background: Childhood sexual abuse (CSA) is associated with health problems, including cardiometabolic outcomes. Findings directly linking CSA to cholesterol levels are mixed, and identifying mediating pathways is the next logical step. Body mass index (BMI) is one possible mediator, given its association with both CSA and cardiometabolic outcomes. Gendered effects of CSA indicates that BMI may operate differently in men and women. Objective: We tested BMI as a mediator linking CSA to high-density lipoprotein (HDL) and lowdensity lipoprotein (LDL) using a multiple group structural equation model stratified across gender to test the indirect effects. Participants and setting: We utilized a sample of 1054 adults (54.7 % women) from the study of Midlife Development in the United States, who were drawn from the general population. Methods: Using two waves of data, participants responded to a questionnaire assessing CSA, provided measurements from which to calculate BMI, and a fasting blood sample from which cholesterol levels were measured. Results: The indirect effects in the overall sample yielded a significant effect from CSA to HDL via BMI (beta = -0.03, 95 % CI [-0.050, -0.010]), but not LDL (beta = 0.006, 95 % CI [-0.002, 0.014]). The indirect effect from CSA to HDL cholesterol was significant among women (beta = -0.04, 95 % CI [-0.066, -0.012]) only. Indirect effects to LDL among both genders were both non-significant. Conclusions: BMI appears to be a possible mediator linking CSA to lower HDL cholesterol among women suggesting BMI could be a point of trauma-informed prevention and intervention especially impactful.